Organization
TABULA RASA RENEWED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORDETT D MCCALL LMHC (PRESIDENT)
(407) 272-3700
Entity
Organization
Contact information
Practice address
702 PARK LAKE ST, ORLANDO, FL 32803-4024
(407) 272-3700
Mailing address
702 PARK LAKE ST, ORLANDO, FL 32803-4024
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/25/2013
Last updated
03/25/2013
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